Sjogren syndrome and mixed nephropathy. Significance of early kidney biopsy

M. Adoración Martín-Gómez, Mercedes Caba Molina, Gracia Cruz Caparros, Javier Muñoz Vico, Mercedes Gómez Morales
2016 Nefrología (English Edition)  
n e f r o l o g i a. 2 0 1 6;3 6(4):444-463 451 given her C-peptide level below one and her expected treatment with recombinant human leptin, requested for compassionate use. She received a double kidney-pancreas transplant on 07/09/2015, with an intestinal bypass. She also received induction with ATG-Fresenius (anti-human T-lymphocyte immunoglobulin from rabbits) (15 mg/kg divided into 5 doses), antibacterial prophylaxis for 5 days with piperacillin/tazobactam, an antifungal agent for one
more » ... , an anti-cytomegalovirus (CMV) agent (for 3 months) and an anti-pneumocystis pneumonia (PCP) agent for 2 years. Maintenance immunosuppression was added with belatacept (de novo) and tacrolimus/Deltisona (methylprednisolone)/mycophenolate sodium. The indication for belatacept was due to the patient's vascular/metabolic risk and to initial efforts to decrease the dose of tacrolimus (relative to the standard dose) to later suspend it in the long term. The grafts functioned immediately; neither insulin nor haemodialysis was required. In the postoperative period, the patient had intercurrent intestinal obstruction with an anastomosis fistula, which required conversion to a new Roux-en-Y duodenojejunostomy. She also had a low-output pancreatic fistula, which closed without complications. Currently, the patient has normal renal and pancreatic function, with the following values: fructosamine 237 mol/l (normal level [NL] 285 mol/l), HbA1c 4.6% (NL 2.5%-5.9%), C-peptide 1.8 ng/ml (NL 0.5-2 ng/ml), creatinine 0.8 mg/dl (NL 0.8-1.4 mg/dl) and no proteinuria. Tacrolimus levels of 6 ng/ml are being maintained. This is the first report of a double kidney-pancreas transplant with a favourable course in a patient with congenital partial lipodystrophy and a new immunosuppressant regimen.
doi:10.1016/j.nefroe.2016.07.003 fatcat:cuf4n3xp5zdmxc4jjwzx3i3bum